Submitted by Claudia Slater
Director of Development and Public Affairs
During my short journey called “life” I developed a disability early on in the adult stage of life. I have come to accept that every day will be fraught with change(s) and challenge(s) with respect to my disability.
In writing this article I began by asking myself, “What is the definition of change?” and similarly that of challenge(s). Change, is defined as “to make the form, nature, content, future course, etc., of (something) different from what it is or from what it would be if left alone.” And a Challenge is “something that by its nature or character serves as a call to battle or contest.”
When Managed Care Organizations, (MCO) became the “the new healthcare” used by profit based businesses and their shareholders, the main goal of MCOs was to make a lot of money. The call to “battle/contest” that ensued was between them and the business leaders and their individual plan holders. The battle would be remembered as MCOs self-appointing their stature as the “Darth Vader” of healthcare, changing our person-centered decisions into a program under which our bodies and lives are a financial liability to their business model of profit & loss.
Having said that, change is perceived differently by every person or entity depending on their vantage point; it can be positive AS WELL AS negative. It all depends where you are evaluating from. According to John Maltby, MSW, Director of Community Support Programs at Westchester Institute for Human Development in Valhalla, NY:
“State and Federal policy are finally aligned with some of the most cherished goals of people with I/DD
and:
- People with I/DD will be able to exercise Self Determination;
- An objective, transparent Needs Assessment will be rooted in functional support rather than based on perceived deficits or diagnosis;
- A budget will be based on the Needs Assessment rather than on available provider service menus;
- Money will Follow the Person, rather than following the provider industry;
- People with I/DD will include budgetary and hiring authority;
- Institutions will be closed.”
While some may feel that policies are in alignment, there are other problems here in New York State (NYS). Dr. Robert Maher, CEO and Dr. Catherine Morrison, Assistant Director at St. Christopher’s, Inc. in Dobbs Ferry, NY write:
“As we understand this matter, the current issue involves the Federal Office of Inspector General saying the NYS has received overpayment of $1.1 billion Medicaid reimbursements, specifically to the OPWDD system. NYS providers contend that they consistently followed the rules laid out to them and no pay back should be needed. The Feds are looking for a payback and from their perspective, since $1.1 billion has been overpaid, they would have to make cuts into the funding for OPWDD services going forward. There are those who say that this situation will inevitably hurt many other services, outside of the OPWDD system, perhaps the OMH or OCFS systems.”
And they go on to conclude that:
“The ability of our youth to make it in the world requires a variety of supportive services, many of which are funded by Medicaid dollars. Cuts to the monies received by these systems will undermine the critical care that can make the lives of the disabled more equitable and more productive. Thus, since our students and their families are so vulnerable even WITH the support – to cut back on such necessary support can only make a difficult situation worse.”
It is the author’s opinion that, policy makers have concluded that the way to generate revenue when managing policies effecting people with disabilities, is to employ the strategy of confusion. Consumer/provider confusion tactics are a way of deflecting attention and controlling what should be an adult conversation about healthcare. There needs to be a reasonable solution for consumers, providers, and insurers rather than a unilateral mandate which has only one outcome: the inhumane treatment of our fellow citizens with disabilities.
My opinion is not based on speculation, but rather it is substantiated in part by one of our various community partners in Yonkers, NY who state in part:
“the change to the Medicaid Managed Care Organization (MCO, MLTCO, Medicaid Health Home) program in New York State has had a major effect on Home Care Providers, particularly with respect to the following:
- The various MCOs have different/inconsistent requirements regarding: criteria used in their Nursing Assessments of patients’ need for approval of sufficient amount of Aide hours to ensure that they can remain safe at home; differing documentation requirements from patients and their doctors and different time frames for submission; different MCO Initial Service Authorization procedures and Re-Authorization procedures and time frames; (with) different method(s) of notification to patients and providers.
- The cuts in funding have resulted in difficulties meeting new mandates and regulations which may result in serious cuts in services and benefits for the patients.
- The switch to MCO oversight of home care frequently results in patient confusion as to which agency/organization is administering the patient’s benefits and in a lack of information about changes to the individual’s benefits. Patients who have been receiving ongoing Aide services from specific Home Care Providers of their choice often do not know whether their Home Care Provider has a contract in place with the MCO the patient enrolls in. If their Home Care Provider of record has not contracted with the patient’s new MCO, they no longer are allowed to provide Aide services to the patient. Therefore, fragile, ill, elderly patients may be forced to change to a new Home Care Provider that
is not of their own choice in some circumstances.”
Regardless as to whether you agree we are on the right track or not, at the end of the day it will come down to how we face challenges. Some will evaluate them quantitatively, while others qualitatively. We need a system which helps us assess the “challenges/barriers” our disabilities have presented to us in our lives and create a palatable person-centered solution to removing the barriers. While this may seem like a tall order, there are various supports available to you in, your community and in your life and you just need to ask for help and rid yourself of feeling like you are a victim. You are stronger than you thinkJ”